Electronic pillbox boosts remote care for diabetics

A telehealth program for patients with poorly controlled diabetes showed encouraging results, though it involved a small sample made up primarily of African-American women, according to research published this month in Telemedicine and e-Health.

The three-month program involved 30 participants from an urban poor clinic population and was designed as a non-urgent service to complement usual medical care. Each participant was given a Bluetooth-enabled blood glucose monitor, automatic blood pressure cuff and an electronic pillbox. These pillboxes provided automatic data uploaded via a cellular communications network, and provided the patient with daily organization of pills, adherence reminders, and feedback on adherence patterns. They also offered alerts and clinical decision support (CDS) summaries to physicians.

Device readings were uploaded automatically from the devices to a secure website, and the data then were pushed to an existing "diabetes dashboard'' CDS application.

Two clinical nurse care coordinators called participants at two, four and eight weeks, and responded to incoming alerts as needed.

Twenty-nine of the 30 participants completed the entire study. Mean weekly medication adherence was 80 percent for the full 12 weeks of the program, rising to more than 90 percent in the final weeks. Improvement in blood glucose control was clinically and statistically significant with an HbA1c drop of 0.6 percent from a baseline of 8.3 percent over the three-month period.

Participants reported high levels of satisfaction with the program, and providers rated it highly for clarity and ease of use. Providers, however, would like to see the reports, which were delivered as a hard copy .pdf file into the patient's electronic medical record inbox, incorporated into the active patient management areas of the electronic medical record.

Another article in this month's Telemedicine and e-Health noting the potential for telemedicine intervention to improve diabetes care pointed to a three-year study of patients with Type 2 diabetes in Montana that found telemedicine an "effective mode" of care for rural patients compared to more traditional care.

Riverside-San Bernardino County Indian Health in California is using telehealth to address diabetes among members of the nine tribes it serves in the Inland Empire. Many of the patients live in rural counties and do not have easy access to specialists.

To learn more:
- read the article (.pdf)

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